Broth Culture Testing for Interstitial Cystitis

Aetna considers broth culture testing for interstitial cystitis experimental and investigational because there is inadequate evidence of the effectiveness of this test in the diagnosis and management of interstitial cystitis.

Background

Interstitial cystitis (IC) is a treatable but essentially incurable chronic condition of the bladder manifested by urinary urgency, frequency, and bladder pain. It is of unknown etiology. Researchers are working to understand the causes of IC and to find effective treatments; however, no compelling evidence for any hypothesized cause is available at this time (Stenchever, 2001; Hanno, 2002).

The diagnosis of IC is primarily one of exclusion, made from the combination of symptoms, cystoscopic findings and bladder biopsies (Hanno, 2002; Selo-Ojeme, 2004). Hanno (2002) recommends a bladder biopsy only if necessary to rule out other disorders that might be suggested by the cystoscopic appearance. Some of the symptoms of IC resemble those of bacterial infection, but medical tests reveal no organisms in the urine of patients with IC and antibiotic therapy is of no therapeutic benefit (Hanno, 2002; Chancellor, 2004).

Using a specific broth culturing method developed by a microbiologist, a team of Virginia medical researchers are investigating a theory that IC is caused by gram-positive bacteria. This view is contrary to the peer-reviewed published literature that IC is of non-bacterial origin. The broth culturing method is based on pure culture technology and requires initial culture of urine specimens in broth culture to allow all microbial strains from the specimens to emerge. By transfer aliquots to appropriate differential media, the etiologic agent can then be isolated for further study and reported to the physician along with the appropriate antibiotic sensitivity pattern (Interstitial Cystitis Information Center website). Results by this team of researchers have not been published.

According to Duncan (1997) and Hanno (2002), attempts to show an infectious etiology for IC have been made for a number of years; however, none of these approaches has provided convincing evidence that micro-organisms or viruses are associated with IC. Thus, there are little data to support the role of an infectious etiology for IC or the use of antibiotics in treatment of IC.

The American Urological Association’s clinical practice guideline on “Diagnosis and treatment of interstitial cystitis/bladder pain syndrome” (Hanno et al, 2011), a review on “Methods and incentives for the early diagnosis of bladder pain syndrome/interstitial cystitis” (Fall and Peeker, 2013), as well as UpToDate reviews on “Pathogenesis, clinical features, and diagnosis of interstitial cystitis/bladder pain syndrome” (Clemens, 2013a) and “Management of interstitial cystitis/bladder pain syndrome” (Clemens, 2013b) do not mention the use of broth culture testing.

CPT Codes / HCPCS Codes / ICD-9 Codes

Other CPT codes related to the CPB:

87086

Culture, bacterial; quantitative colony count, urine

87088

with isolation and presumptive identification of each isolate, urine

87181 - 87190

Susceptibility studies, antimicrobial agents

Other HCPCS codes related to the CPB:

P7001

Culture, bacterial, urine; quantitative, sensitivity study

ICD-9 codes not covered for indications listed in the CPB:

595.1

Chronic interstitial cystitis

CPT Codes / HCPCS Codes / ICD-10 Codes

Information in the [brackets] below has been added for clarification purposes. &nbspCodes requiring a 7th character are represented by "+":

Additional Information

Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.

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